Whether a drug is available on the National Health Service (NHS) here in the UK is essentially decided by an organisation known as the National Institute for Health and Clinical Excellence (NICE). NICE makes its decisions on drugs based on the cost per ‘quality adjusted life year‘ (QALY). A year in perfect health is 1 QALY. A year with some chronic illness of disability will be something less than 1 QALY.
Yesterday, based on its normal calculations, NICE took the decision for a prostate cancer drug to be banned from provision by the NHS. Basically, the drug does not provide good value for money. This morning, a piece appears in the paper The Independent which highlights the fact that as is often the case, a charity is rails against NICE’s decision. The author of the piece, Jeremy Laurence, specifically mentions objections raised by the Prostate Cancer Charity regarding yesterday’s decision. He also cites objections raised by the charity Beating Bowel Cancer regarding a similar situation with a bowel cancer drug.
Jeremy Laurance makes the point that not all treatments can be made available to all patients irrespective of cost. And he also asks why the ire of charities always seems to be directed at NICE, and not the drug companies. After all, we know that pharmaceutical drugs have a generally spectacular mark-up, and there might be some room for some reduction in price while still preserving a healthy profit for the drug companies.
Jeremy Laurance asks if we should know if there is some conflict of interest within patients groups and charities, in the form of pharmaceutical funding. Back in 2008, Jeremy’s own publication conducted an investigation into such matters which it reported here. This article claims that Beating Bowel Cancer received 10 per cent of its income from drug companies.
I personally have looked into the funding of health charities before. My overwhelming experience is that it’s generally hard to find information about this and true transparency. This morning, I went looking for information about the funding of the Prostate Cancer Charity. I found this document which outlines the charity’s policy regarding funding from pharmaceutical companies. It was published in July 2008, and states is due for revision in July 2010, but it does not appear to have been reviewed.
Here’s a quote from the opening page of the document:
Whilst we acknowledge that support from pharmaceutical companies is an important resource, we recognise that partnerships with these companies should be approached with caution. The Prostate Cancer Charity seeks to make clear that it will not permit any company with a direct commercial interest in prostate cancer to influence its activities.
Would it be unduly cynical for some of us to have a ‘they would say that’ attitude to this statement? Here’s another quote, this one from the 2008 piece in the Independent. It comes from Tim Kendall, director of research at the Royal College of Psychiatrists:
Drug companies will try to do anything to align their interest with those of patients. They do things at every level of the health service and we know they do it with patient groups.
It is a multi-pronged approach to persuade patients that their drug is the one.